Resident Rounds

A 15-year-old white male was brought to the emergency department for evaluation of chronic vomiting and abdominal pain. His symptoms began approximately 3 years ago with intermittent vomiting, sometimes associ-ated with meals. For the past 3 months, he has had daily episodes of vomiting severe enough to keep him awake all night. Vomiting has been preceded by headaches and associated with abdominal cramps. The patient has a history of constipation, somewhat managed by laxa-tives. In the past 3 months, he has lost approximately 25 lb and has become a very picky eater. He has been evaluated by his primary care doctor several times for these symptoms, and he has been treated with antacids, with minimal relief. An upper gas-trointestinal endoscopy done 2 years ago was normal